Healthcare Provider Details

I. General information

NPI: 1043841208
Provider Name (Legal Business Name): IVONNE LEONELA LISETTE PALACIOS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST STE 408
HIALEAH FL
33012-3489
US

IV. Provider business mailing address

900 W 49TH ST STE 408
HIALEAH FL
33012-3489
US

V. Phone/Fax

Practice location:
  • Phone: 800-633-9680
  • Fax:
Mailing address:
  • Phone: 800-633-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: